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<html>
<head>
<meta charset="utf-8">
<title>激活5-4</title>
<meta name="keywords" content="众安保险，互联网保险，网上支付，保单查询，在线理赔，让保险有温度" />
<meta name="description" content="众安保险是国内首家也是唯一一家互联网保险公司，个性化定制风险解决方案，全方位采用互联网先进科技，追求流畅、贴心、温暖的用户体验。" />
<!--统一加载公共js与css文件-->
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<meta name="viewport" content="width=device-width,initial-scale=1.0,minimal-ui,maximum-scale=1.0,user-scalable=0" />
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="apple-mobile-web-app-capable" content="yes">
<meta name="apple-mobile-web-app-status-bar-style" content="black">
<meta name="format-detection" content="telephone=no" />
<link rel="apple-touch-icon-precomposed" sizes="57x57" href="../../image/apple_icon/zhongan_icon_52.png" />  
<link rel="apple-touch-icon-precomposed" sizes="72x72" href="../../image/apple_icon/zhongan_icon_72.png" />  
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<link type="image/x-icon" rel="Shortcut Icon" href="../../image/apple_icon/zhongan_icon_144.png">
<link href="../../css/za-web-common.css" rel="stylesheet">
<script type="text/javascript" src="../../js/form/zepto.min.js"></script>
<script type="text/javascript" src="../../js/form/sea.js"></script>
<script type="text/javascript" src="../../js/web_common.js"></script>
</head>
<body>
<div class="activation-contain">
<form id="CM_Form" action="卡式确认.html" method="post" autocomplete="off">
  <div class="form-box">
    <div class="form-title">
      投保人信息
    </div>
    <div class="form-list">
      <div class="form-list-left w70">
        常用投保人
      </div>
      <div class="form-list-auto">
        <select class="form-select user-select">
          <option value="1">盛柏青</option>
          <option value="2">盛柏青2</option>
        </select>
      </div>
    </div>
    <div class="form-list">
      <div class="form-list-left">
        姓名
      </div>
      <div class="form-list-auto">
        <input type="text" value="" name="policyman" data-rules="{required:true}" data-messages="{required:'请输入投保人'}" placeholder="请输入您的真实姓名" />
      </div>
    </div>
    <div class="form-list">
      <div class="form-list-left">
        证件类型
      </div>
      <div class="form-list-auto">
        <select class="form-select certype-select">
          <option value="1">身份证</option>
          <option value="2">军官证</option>
          <option value="3">港澳通行证</option>
          <option value="3">沿用原有证件</option>
        </select>
      </div>
    </div>
    <div class="form-list">
      <div class="form-list-left">
        证件证号
      </div>
      <div class="form-list-auto">
        <input type="text" class="idCard" id="idCard" maxlength="18" value="" name="shenfenzheng" data-rules="{required:true,isIdCard:'请输入正确证件号!'}" data-messages="{required:'请输入您的证件号码',isIdCard:'请输入正确证件号!'}" placeholder="" />
      </div>
    </div>
    <div class="form-list">
      <div class="form-list-left">
        出生日期
      </div>
      <div class="form-list-auto">
        <input type="date" class="form-date" value="" name="birthdate" data-rules="{required:true}" data-messages="{required:'请输入出生日期'}" placeholder="" readonly="readonly" />
      </div>
    </div>
    <div class="form-list">
      <div class="form-list-left">
        手机号码
      </div>
      <div class="form-list-auto">
        <input type="text" maxlength="11" value="" name="mobile" data-rules="{required:true,mobile:'请输入有效的手机号码'}" data-messages="{required:'请输入手机号码',mobile:'请输入有效的手机号码'}" placeholder="" />
      </div>
    </div>
    <div class="form-list">
      <div class="form-list-left">
        邮件地址
      </div>
      <div class="form-list-auto">
        <input type="text" maxlength="11" value="" name="email" data-rules="{required:true,email:'请输入有效的邮件地址'}" data-messages="{required:'请输入邮件地址',email:'请输入有效的邮件地址'}" placeholder="" />
      </div>
    </div>
    <div class="form-list">
      <div class="form-list-auto tc">
        <span class="za_web_icon_agree">
          <input type="checkbox" id="cbtest">
            <label for="cbtest" id="cbtest_lab" class="check-box2 inb">
              保存为常用投保人
            </label>
        </span>
      </div>
    </div>
  </div>
  <div class="form-box">
    <div class="form-title">
      被保人信息
    </div>
    <div class="form-list">
      <div class="form-list-left w90">
        与投保人关系
      </div>
      <div class="form-list-auto">
        <select class="form-select contect-select">
          <option value="1">本人</option>
          <option value="2">父母</option>
          <option value="2">子女</option>
          <option value="2">其他</option>
        </select>
      </div>
    </div>
    <!-- <div class="contect-room" style="display:none;">
      <div class="form-list">
        <div class="form-list-left">
          姓名
        </div>
        <div class="form-list-auto">
          <input type="text" value="" name="policyman2" data-rules="{required:true}" data-messages="{required:'请输入被保人'}" placeholder="请输入您的真实姓名" />
        </div>
      </div>
      <div class="form-list">
        <div class="form-list-left">
          证件类型
        </div>
        <div class="form-list-auto">
          <select class="form-select certype-select">
            <option value="1">身份证</option>
            <option value="2">军官证</option>
            <option value="3">港澳通行证</option>
            <option value="3">沿用原有证件</option>
          </select>
        </div>
      </div>
      <div class="form-list">
        <div class="form-list-left">
          证件号码
        </div>
        <div class="form-list-auto">
          <input type="text" class="idCard" id="idCard" maxlength="18" value="" name="shenfenzheng2" data-rules="{required:true,isIdCard:'请输入正确证件号!'}" data-messages="{required:'请输入您的证件号码',isIdCard:'请输入正确证件号!'}" placeholder="" />
        </div>
      </div>
      <div class="form-list">
        <div class="form-list-left">
          出生日期
        </div>
        <div class="form-list-auto">
          <input type="date" class="form-date" value="" name="birthdate2" data-rules="{required:true}" data-messages="{required:'请输入出生日期'}" placeholder="" readonly="readonly" />
        </div>
      </div>
      <div class="form-list">
        <div class="form-list-left">
          手机号码
        </div>
        <div class="form-list-auto">
          <input type="text" maxlength="11" value="" name="mobile2" data-rules="{required:true,mobile:'请输入有效的手机号码'}" data-messages="{required:'请输入手机号码',mobile:'请输入有效的手机号码'}" placeholder="" />
        </div>
      </div>
      <div class="form-list">
        <div class="form-list-left">
          邮件地址
        </div>
        <div class="form-list-auto">
          <input type="text" maxlength="11" value="" name="email2" data-rules="{required:true,email:'请输入有效的邮件地址'}" data-messages="{required:'请输入邮件地址',email:'请输入有效的邮件地址'}" placeholder="" />
        </div>
      </div>
    </div> -->
  </div>
  <div class="zaw-btn-box plr10">
    <div class="zaw-btn-box-room"><a href="javascript:void(0);" id="zaw-btn" class="zaw-btn zaw-btn-blue-bg">下一步</a></div>
  </div>
</div>
</div>
<script type="text/javascript" src="../../js/html/order/order.js"></script>
</body>
</html>